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Observational Study
. 2021 Dec:159:194-204.
doi: 10.1016/j.ejca.2021.09.005. Epub 2021 Nov 11.

Nasopharyngeal cancer in non-endemic areas: Impact of treatment intensity within a large retrospective multicentre cohort

Paolo Bossi  1 , Annalisa Trama  2 , Alice Bernasconi  3 , Salvatore Grisanti  4 , Issa Mohamad  5 , Isabel L Galiana  6 , Enis Ozyar  7 , Pierfrancesco Franco  8 , Stefania Vecchio  9 , Pierluigi Bonomo  10 , Beatriz C Cirauqui  11 , Mustafa El-Sherify  12 , Stefano Ursino  13 , Athanassios Argiris  14 , Jonathan Pan  15 , Claus Wittekindt  16 , Elisa D'Angelo  17 , Loredana Costa  18 , Michela Buglione  19 , Jennifer Johnson  20 , Mario Airoldi  21 , Ricard Mesia  22 , Carlo Resteghini  23 , Lisa Licitra  24 , Ester Orlandi  25 ; Nasopharyngeal Cancer Portal Group of Investigators
Collaborators, Affiliations
Observational Study

Nasopharyngeal cancer in non-endemic areas: Impact of treatment intensity within a large retrospective multicentre cohort

Paolo Bossi et al. Eur J Cancer. 2021 Dec.

Abstract

Aim: Recommendations for managing patients with nasopharyngeal carcinoma (NPC) in non-endemic areas are largely derived from studies conducted in endemic areas. We analysed the impact of treatment approaches on survival in non-endemic areas.

Methods: In an international, multicentre, retrospective study, we analyse consecutive patients with NPC diagnosed between 2004 and 2017 in 36 hospitals from 11 countries. Treatment was categorised as non-intensive (NIT), including radiotherapy alone or concomitant chemoradiotherapy (cCRT), and intensive (IT) including cCRT preceded by and/or followed by chemotherapy (CT). The impact of IT on overall survival (OS) and disease-free survival (DFS) was adjusted for all the available potential confounders.

Results: Overall, 1021 and 1113 patients were eligible for overall survival (OS) and disease-free survival (DFS) analyses, respectively; 501 and 554 with Epstein Barr-encoded RNA (EBER) status available. In the whole group, 5-year OS was 84% and DFS 65%. The use of NIT was associated with a risk of death or recurrence 1.37 times higher than patients receiving IT. Patients submitted to NIT and induction CT + concurrent concomitant chemo and three-dimensional Conformal Radiation Therapy (3DCRT) had a risk of death or recurrence 1.5 and 1.7 times higher than patients treated with induction CT + cCRT with intensity-modulated radiotherapy (IMRT), respectively. The IT had no impact on OS in neither patients with EBER+ nor in patients with EBER-; IT showed better DFS in EBER+ but not in patients with EBER-.

Conclusions: In low-incidence areas, patients with NPC treated with induction CT followed by concurrent IMRT cCRT achieved the highest DFS rate. The benefit of IT on DFS was restricted to patients with EBER+, suggesting that additional therapy offers no advantages in EBER- cases.

Keywords: Adjuvant chemotherapy (ACT); Disease-free survival (DFS); Epstein Barr-Encoded RNA (EBER); Induction chemotherapy (ICT); Intensity-modulated radiotherapy (IMRT); Nasopharyngeal carcinoma (NPC); Overall survival (OS).

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Conflict of interest statement

Conflict of interest statement Bossi reports personal fees from Merck, Sanofi Regeneron, BMS, MSD, GSK, Astrazeneca, Sunpharma, Angelini and grants from GSK and Sunpharma, outside the submitted work. Buglione reports personal fees from Meck Serono, outside the submitted work. Cirauqui Cirauqui reports congress support from MSD, Merck, BMS and Roche, and personal fees from BMS and Roche, outside the submitted work. Ursino reports grants from Merck Serono, Nestlé, Kyowakirin and Astra Zeneca, outside the submitted work. D'angelo reports personal fees from Astra Zeneca, Nestlé and Merck Spa, outside the submitted work. Licitra reports personal fees and grants from Astra Zeneca, Bayer, BMS, Boehringer ingelheim, Debiopharm International SA, EISAI, Merck Serono MSD, Novartis, Roche; Personal fee from Bayer, SOBI, IPSEN, GSK, Doxa Pharma srl, Incyte Biosciences Italy srl, Amgen, Nanobiotics Sa; Grants from Celgene International, Exelixis inc, grants Hoffmann-La Roche ltd, IRX Therapeutics incMedpace inc, grants Pfizer, outside the submitted work. Mesia reports Consulting and advisory role for Merck, MSD, Roche, Asta Zeneca, BMS and speaker's Bureau for Merck, MSD, BMS, Roche. All the other authors have nothing to disclose.

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